Common Reasons for Seeking Treatment

The Before & After examples that follow illustrate a variety of dental conditions along with their treatment results. Individuals may seek treatment to resolve one or a number of these issues in combination. As you will see below, each of these conditions can be addressed successfully.

Crowding of the teeth

Crowding of the teeth is one of the most common issues addressed with orthodontic treatment. Mild to moderate crowding is typically successfully addressed by keeping all of the teeth and allowing the braces to move them into their ideal positions. Severe crowding is usually indicative of a situation in which the size of the teeth relative to the size of the jaws is out of synch. Forcing the teeth to “fit in” could result in permanent damage including recession of the gums and bone loss. In this case, removal of teeth in addition to the placement of braces may be utilized to achieve the most ideal result. Each case is evaluated by comprehensive exam and diagnostic records priorÂ making any final decisions regarding tooth removal.

Deep overbite: Lower front teeth bite into palate

Deep overbite is another common occurrence. If left untreated, the edges of the upper and lower front teeth can undergo extensive wear and tear, leaving them permanently damaged. In a case like this, bite blocks are placed in addition to the braces. Bite blocks are small, clear acrylic blocks that are attached behind the upper front teeth. They are not visible from the front. The blocks allow the lower front teeth to close into their ideal final position. The braces are then used to move the rest of the teeth into position. The blocks are removed at the end of treatment.

Overbite: Protruding front teeth

Protrusion of the upper front teeth is typically a result of the poor alignment of the upper and lower molars relative to each other, with the uppers being more forwardly placed. In cases of mild to moderate protrusion, elastics that stretch from the top to the bottom teeth are often used in conjunction with braces. In severe cases of protrusion, removal of two upper teeth may be indicated in order to ideally realign the position of the front teeth relative to each other. No tooth removal is ever planned without first performing a comprehensive exam and taking diagnostic records.

Spacing of teeth

Closure of spaces is generally readily achieved by the placement of braces and the use of special elastic chain that moves the teeth together to close spaces. Spaces can also have a tendency to reopen following the completion of treatment. For this reason, fixed (permanent) retainers are typically utilized in these cases to prevent the onset of relapse (spaces reopening).

Phase I

Phase I treatment can be indicated for a number of reasons, the most common of which is the need for early intervention in the case of a crossbite, a mismatch of the width of the upper and lower jaws, which if left uncorrected, can result in significant bite and growth asymmetry. Correction is commonly accomplished by the placement of a palatal expander. This increases the size (width) of the upper jaw, correcting the fit of the two jaws together. The ideal time to accomplish this correction is while the patient is still growing and before all of the permanent teeth have erupted. Typically this is followed by comprehensive orthodontic treatment once the permanent teeth have all erupted to address other bite concerns that may be present.

Openbite: Front teeth don’t touch

Openbite is one of the most complex situations that an orthodontist can face. It can be related to an oral habit, like thumb sucking, a forward tongue thrust, a tooth positional issue, a jaw positional issue, or a combination of the more than one of the above. As a result, correction may involve multiple treatment approaches including, palatal expansion, braces, tooth removal, or even jaw surgery could be involved to achieve the most ideal result. Lifetime fixed (permanent) retention is a must.

Underbite: Lower front teeth in front of upper teeth

Underbite is another complex situation that orthodontists face. An underbite can present in varying degrees, including issues that relate directly to the position of the teeth due to tipping, positions of the jaws which results in the lower jaw being positioned ahead of the upper jaw, or a combination of the two, which results in the lower front teeth being positioned in front of the upper front teeth. Correction can include the use of braces with elastics that stretch from the lower to the upper teeth, the removal of a single lower front tooth, the removal of two teeth, or even jaw surgery depending on the severity of the bite, in order to achieve the ideal result.

Missing lateral incisors

Missing lateral incisors (the teeth on either side of the two front teeth) can be addressed by utilizing braces to provide adequate space and alignment of the neighboring teeth in order to plan for their eventual permanent replacement. No permanent restoration should be placed before all growth has completed. In the interim, a retainer with replacement teeth, or a resin bonded bridge attached behind the the upper front teeth can be used to maintain the space until the individual is ready for the placement of permanent implants. In rare circumstances, the spaces are closed, rather than maintained, and the cuspids (eye teeth) can be modified to take the place of the laterals.